Your NamePlace of BirthDate of BirthMother’s Maiden NameSocial Security #Home Address

Driver’s License Number

EmployerAddress of Employer

Employee ID #Human Resource Contact

Telephone Number

Health Care Plan ID #Group ID #Blood TypeOrgan Donor

Passport NumberReligion

CONfIDENTIAL PERSONAL fINANCIAL ORGANIzER

Purpose of this form:This form is meant to be used as a tool to help you organize your personal/confidential information. This form is only a tool. This form is NOT a legal document.

How to use this form:Print form, complete all information. Be sure to provide a copy for your spouse, adult child, trusted friend or advisor. Do not place the only copy in a safe deposit box.

Date this form was completed:

1

Personal Information ........................................................................................................................................

Your NamePlace of BirthDate of BirthMother’s Maiden NameSocial Security #Home Address

Driver’s License Number

EmployerAddress of Employer

Employee ID #Human Resource Contact

Telephone Number

Health Care Plan ID #Group ID #Blood TypeOrgan Donor

Passport NumberReligion

TM

Life Income Management Copyright 2010

Any and all notations made on this form are NOT legally binding. Please consult your attorney.

Disclaimer: The information contained in this form has been completed by the individual and is under the direct control of the individual who has completed this form. All information on this form is deemed highly personal and confidential. Any copies made and provided to any person including a trusted advisor or trusted family

member should be done so with caution and discretion. Be sure to consult an attorney for written legal documents as required.

Life Income Management Copyright 2010

Any and all notations made on this form are NOT legally binding. Please consult your attorney.

Life Income Management Copyright 2010

Any and all notations made on this form are NOT legally binding. Please consult your attorney.

TM

Life Income Management Copyright 2010

Any and all notations made on this form are NOT legally binding. Please consult your attorney.

Disclaimer: The information contained in this form has been completed by the individual and is under the direct control of the individual who has completed this form. All information on this form is deemed highly personal and confidential. Any copies made and provided to any person including a trusted advisor or trusted family

member should be done so with caution and discretion. Be sure to consult an attorney for written legal documents as required.

Life Income Management Copyright 2010

Any and all notations made on this form are NOT legally binding. Please consult your attorney.

Life Income Management Copyright 2010

Any and all notations made on this form are NOT legally binding. Please consult your attorney.

TM

Trusted Advisors ......................................................................................................................................................

Physician

Physician

Physician

Attorney

Accountant

financial Planner

Location of Documents .....................................................................................................................................

Marriage Certificate

Divorce/ Separation Decrees

Military Service Records

Passport (number, location, make a copy of the first page and attach to this inventory)

Important Documents:

Title to Home

Mortgage Documents

Home Equity Loan

Property Insurance

Cost of Home Improvement files

Property Records:

Checkbook/Statements

Income Tax Records (7 years)

Stock Transaction Records

401K Statements or Pension

IRA Statements

Savings Accounts

financial Records:

Make/Model/Year

Make/Model/Year

Make/Model/Year

Auto Insurance Contact

Policy Numbers

Automobile Records:

2

TMLife Income Management Copyright 2010

Any and all notations made on this form are NOT legally binding. Please consult your attorney.

TM

Life Income Management Copyright 2010

Any and all notations made on this form are NOT legally binding. Please consult your attorney.

Disclaimer: The information contained in this form has been completed by the individual and is under the direct control of the individual who has completed this form. All information on this form is deemed highly personal and confidential. Any copies made and provided to any person including a trusted advisor or trusted family

member should be done so with caution and discretion. Be sure to consult an attorney for written legal documents as required.

Life Income Management Copyright 2010

Any and all notations made on this form are NOT legally binding. Please consult your attorney.

Life Income Management Copyright 2010

Any and all notations made on this form are NOT legally binding. Please consult your attorney.

TM

Location of Documents continued ...........................................................................................................................

Living Trust/ Will (Location of copy, attorney contract, latest date revised)

Successor Trustee/ Executor (Name, phone number)

Living Will (Attach copy, name, contact of empowered person)

Health Care Power of Attorney (Name of empowered person, location of document)

Location of Medical Records

Organ Donor Instruction Card

funeral Instructions/Cemetery Deed

Agents Name/Phone/Email

Location of Policies

Company Policy # Type (cash, term)

On Life of Beneficiary

Company Policy # Type (cash, term)

On Life of Beneficiary

Company Policy # Type (cash, term)

On Life of Beneficiary

Estate Planning Records:

Life Insurance ........................................................................................................................................................

Notes .........................................................................................................................................................................

3

Life Income Management Copyright 2010

Any and all notations made on this form are NOT legally binding. Please consult your attorney.

Disclaimer: The information contained in this form has been completed by the individual and is under the direct control of the individual who has completed this form. All information on this form is deemed highly personal and confidential. Any copies made and provided to any person including a trusted advisor or trusted family

member should be done so with caution and discretion. Be sure to consult an attorney for written legal documents as required.

Life Income Management Copyright 2010

Any and all notations made on this form are NOT legally binding. Please consult your attorney.

Life Income Management Copyright 2010

Any and all notations made on this form are NOT legally binding. Please consult your attorney.

TM

Stored Numbers as of: Date(Take the time to make a list of names/numbers, just in case your phone is lost or stolen!)

Contact Number for Cell Phone Provider to Report Lost/Stolen Phone:

......................................................................................................................................................................Children

Cell Phone ....................................................................................................................................................

Name Birth Date Social Security No.Contact Number:

Name Birth Date Social Security No.Contact Number:

Name Birth Date Social Security No.Contact Number:

Name Birth Date Social Security No.Contact Number:

Name Birth Date Social Security No.Contact Number:

Name Birth Date Social Security No.Contact Number:

Additional Information .................................................................................................................................................

Contact Number:

Provider:

Contact Number:

Provider:

4

Life Income Management Copyright 2010

Any and all notations made on this form are NOT legally binding. Please consult your attorney.

Disclaimer: The information contained in this form has been completed by the individual and is under the direct control of the individual who has completed this form. All information on this form is deemed highly personal and confidential. Any copies made and provided to any person including a trusted advisor or trusted family

member should be done so with caution and discretion. Be sure to consult an attorney for written legal documents as required.

Life Income Management Copyright 2010

Any and all notations made on this form are NOT legally binding. Please consult your attorney.

Life Income Management Copyright 2010

Any and all notations made on this form are NOT legally binding. Please consult your attorney.

TM

...................................................................................................................................In Case of An Emergencyfamily & friends to Notify

Name: Contact Number:

Name: Contact Number:

Name: Contact Number:

Name: Contact Number:

Name: Contact Number:

Name: Contact Number:

Name: Contact Number:

Name: Contact Number:

Name: Contact Number:

Name: Contact Number:

Name: Contact Number:

Name: Contact Number:

Notes .........................................................................................................................................................................

5

Life Income Management Copyright 2010

Any and all notations made on this form are NOT legally binding. Please consult your attorney.

Disclaimer: The information contained in this form has been completed by the individual and is under the direct control of the individual who has completed this form. All information on this form is deemed highly personal and confidential. Any copies made and provided to any person including a trusted advisor or trusted family

member should be done so with caution and discretion. Be sure to consult an attorney for written legal documents as required.

Life Income Management Copyright 2010

Any and all notations made on this form are NOT legally binding. Please consult your attorney.

Life Income Management Copyright 2010

Any and all notations made on this form are NOT legally binding. Please consult your attorney.

TM

Notes .........................................................................................................................................................................

6